Archived: Family Mosaic - St Leonards

This inspection took place on 14 July 2015. We gave short notice of the inspection because the registered manager was often managing the service away from the office base and meeting people who used the service. We needed to be sure that they would be available to speak with us.

Family Mosaic – St Leonards is a domiciliary care agency registered to provide personal care to people living in their own homes. 162 people used the service at the time of our inspection. Some people who used the service were older people including people living with dementia, or people with learning and/or physical disabilities.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Staff were trained in the safe administration of medicines. Between 16 January 2015 and 01 June 2015 we received information about six medicines errors. The registered manager worked closely with the Local Authority and staff to address these concerns. Whilst the number of medicines records errors had greatly reduced, there was still a significant number of inaccurate Medicines Administration Records (MAR) identified as part of the provider’s medicines audit. No one had suffered harm due to the lack of medicine recording by staff. Although improvement plans were in place to address concerns and improvements had been made, further improvements were required.

The lack of accurate and consistent medicines records is a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff had completed training in the principles of the Mental Capacity Act 2005 (MCA). However some staff could not explain the requirements of the legislation or how they protected people’s rights to make their own decisions. The registered manager had not completed mental capacity assessments to determine whether people had the capacity to consent to their care and treatment following guidelines set out in the MCA 2005 Code of Practice.

The lack of mental capacity assessments completed to demonstrate people had consented to their care is a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some staff did not receive regular supervision to discuss their development needs. Some staff said they had not received the training they needed to meet people’s individual needs, for example supporting people living with dementia and end of life care.

The lack of regular supervision and adequate staff training to meet people’s individual needs was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff had completed training in how to protect people from abuse and harm. However, some staff were not always confident in recognising signs of abuse to prompt them to raise an alert if they had any concerns. Not all staff were confident in describing the terms of the whistleblowing policy and their duty to report any concerns.

We have made a recommendation about staff training on the subjects of safeguarding and whistleblowing procedures.

There was a lack of consistency of care staff supporting people with their care needs. This made people feel frustrated and anxious as they required consistency of care and support. Some care staff were not always familiar with the individual needs of people they supported, where they provided care at short notice. Although improvement plans were in place to address concerns and improvements had been made, further improvements were needed.

We have made a recommendation about providing continuity of care staff to meet people’s individual care needs and preferences.

Risk assessments were centred on the needs of the individual. Each risk assessment included clear control measures to reduce identified risks and guidance for staff to follow to reduce risks to people.

There were enough staff on shifts to meet people's needs. Staffing levels were calculated according to people’s changing needs and travel time was taken into account to reduce lateness of visiting calls. The registered manager followed safe recruitment practices.

Accidents and incidents were recorded and monitored to identify how the risks of re-occurrence could be reduced.

Staff provided meals when appropriate and ensured they were well balanced to promote people’s health. Staff knew about people’s dietary preferences and needs.

Staff treated people with kindness and respect. Although a small number of people felt staff did not always have time to talk. They did say this was not because staff were unkind but because they were too rushed. People were satisfied about how their care and treatment was delivered where they had consistent care staff visiting them. People’s privacy was respected and people were assisted in a way that respected their dignity.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

People’s individual assessments and care plans were reviewed regularly with their participation or their representatives’ involvement. People’s care plans were updated when their needs changed to make sure they received the care and support they needed. Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people’s needs.

The registered manager took account of people’s complaints, comments and suggestions. People’s views were sought and acted upon. The registered manager sent questionnaires regularly to people to obtain their feedback on the quality of the service. The results were analysed and action was taken in response to people’s views.

There was an open culture where staff could discuss issues and concerns with their supervisors and registered manager. However, staff said they had not been actively asked to contribute ideas to how the service could continuously improve. Staff held a clear set of values based on respect for people, ensuring people had freedom of choice and support to be as independent as possible.

The registered manager notified us of any significant events that affected people or the service. Quality assurance audits were carried out to identify how the service could improve and the registered manager had an action plan for making improvements to address any shortfalls.